Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
The requirement to honor a “Certificate of Credible Coverage” with like a 30-day gap was a fucking godsend, and even then, health plans still didn’t have to cover any minimum set of services, medications, procedures, etc. like they do under the ACA. Insurance providers were free to just be like, “No, we don’t cover chemo at all, period, fuck off.” But more common, by far, was simply not covering prescriptions. Like, at all. You go to the doctor, get fixed up, and here’s to hoping the meds they want to give you are generic, because you’re paying out of pocket.